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Abstract Breast cancer is caused by aberrant breast cells that proliferate and develop into tumors. Tumors have the potential to spread throughout the body and become lethal if ignored. Metastasis is the process by which invasive tumors move to neighboring lymph nodes or other organs. Metastasis can be lethal and perhaps fatal. The objective of our study was to elucidate the molecular mechanisms underlying the transition of Ductal Carcinoma In Situ (DCIS) to Invasive Ductal Carcinoma (IDC), with a particular focus on hub genes and potential therapeutic agents. Using Weighted Gene Co-expression Network Analysis (WGCNA), we built a comprehensive network combining clinical and phenotypic data from both DCIS and IDC. Modules within this network, correlated with specific phenotypic traits, were identified, and hub genes were identified as critical markers. Receiver Operating Characteristic (ROC) analysis assessed their potential as biomarkers, while survival curve analysis gauged their prognostic value. Furthermore, molecular docking predicted interactions with potential therapeutic agents. Ten hub genes—CDK1, KIF11, NUF2, ASPM, CDCA8, CENPF, DTL, EXO1, KIF2C, and ZWINT—emerged as pivotal fibroblast-specific genes potentially involved in the DCIS to IDC transition. These genes exhibited pronounced positive correlations with key pathways like the cell cycle and DNA repair, Molecular docking revealed Fisetin, an anti-inflammatory compound, effectively binding to both CDK1 and DTL underscoring their role in orchestrating cellular transformation. CDK1 and DTL were selected for molecular docking with CDK1 inhibitors, revealing effective binding of Fisetin, an anti-inflammatory compound, to both. Of the identified hub genes, DTL—an E3 ubiquitin ligase linked to the CRL4 complex—plays a central role in cancer progression, impacting tumor growth, invasion, and metastasis, as well as cell cycle regulation and epithelial-mesenchymal transition (EMT). CDK1, another hub gene, is pivotal in cell cycle progression and associated with various biological processes. In conclusion, our study offers insights into the complex mechanisms driving the transition from DCIS to IDC. It underscores the importance of hub genes and their potential interactions with therapeutic agents, particularly Fisetin. By shedding light on the interplay between CDK1 and DTL expression, our findings contribute to understanding the regulatory landscape of invasive ductal carcinoma and pave the way for future investigations and novel therapeutic avenues.

Objective: This study was conducted to evaluate factors that predict uterine rupture following a previous cesarean section. Study Design: A cross-sectional study. Place and Duration of Study: The Study was conducted at the Department of Gynecology, Bakhtawar Amin Hospital Multan, Pakistan from June 2022 to June 2023. Methods: The study included 100 women who had previously given birth. Women who had a successful vaginal birth after cesarean section (VBAC) were controls and who had rupture/scar dehiscence were considered cases. Socio-demographic data and information related to delivery, labor, and pregnancy were collected. Results: A total of 100 women (40 cases and 60 controls) were included in the study. All women had spontaneous onset of labor. 12.5% (8) cases and 85% (51) controls had a successful vaginal birth after the cesarean section (VBAC). 34.1% of all rupture cases happened during the second stage of labor and 41.4% during the latent phase of labor. Upon arrival 30% (12) of cases had shock. Maternal complications in cases included anemia (21 patients), death (2 patients), uterine artery involvement (3 patients), and bladder rupture (4 patients). According to multivariate analysis factors including previous vagina delivery, duration of labor, fetal weight, and number of ANC visits were significantly related to rupture of uterus after previous cesarean (P 3.8 kg increase the likelihood of uterine rupture following a C-section. It is crucial to develop strict criteria, considering intrapartum obstetric care, infrastructure, and referral system, for the selection of favorable candidates for trial of labor. How to cite this: Tabassum S, Khan B, Qureshi HZ, Imran H. Factors Predicting Uterine Rupture Following a Cesarean Section. Life and Science. 2024; 5(4): 446-451. doi: http://doi.org/10.37185/LnS.1.1.540

Podophyllum hexandrum Royle, also known as Podophyllum emodi Wall, holds significant ecological, ornamental, and medicinal values. However, it has become endangered due to overexploitation, prolonged seed dormancy, slow natural regeneration, and climate change. This study developed an efficient in vitro protocol for callogenesis and micropropagation of P. hexandrum to conserve germplasm in in vitro conditions. Callus formation from various plant parts, including the leaf, stem, rhizome, radicle, and cotyledon, was induced using Murashige and Skoog (MS) medium supplemented with different plant growth regulators. The combination of benzyladenine at 1 mg L−1 and 4-dichlorophenoxy acetic acid at 3 mg L−1 was optimal for biomass production, yielding 215.88 ± 0.31 mg, with growth per gram at 8.32 ± 0.32 and a growth rate of 13.62 ± 0.25 mg/day on MS medium. For shoot proliferation, benzyladenine (3.5 mg L−1) and naphthalene acetic acid (0.5 mg L−1) combined with activated charcoal showed the highest shoot induction percentage per explant. For shoot regeneration from calluses, 6-benzylaminopurine (0.5 mg L−1) and thidiazuron (2 mg L−1) were most effective, producing superior shoot length, number of regenerations, and regeneration percentage. Root induction was successful with α-naphthalene acetic acid supplementation (0.5 to 1.5 mg L−1) in MS medium, resulting in the highest number per explant (4.08 ± 0.08), length (5.45 ± 0.15 cm), and rooting rate (87.00 ± 1.66%) of roots in plantlets. Subculturing for callus culture was performed every 28 days for up to four subcultures to prevent nutrient depletion and toxic metabolite accumulation, ensuring tissue health and viability. Continuous subculturing of callus on MS medium maintained healthy P. hexandrum germplasm in vitro. Overall, this micropropagation protocol provides a rapid system for conserving P. hexandrum germplasm.

Chemical-induced neurotoxicity is increasingly recognized to accelerate the development of neurodegenerative disorders (NDs), which pose an increasing health burden to society. Attempts are being made to develop drugs that can cross the blood–brain barrier and have minimal or no side effects. Nobiletin (NOB), a polymethoxylated flavonoid with anti-oxidative and anti-inflammatory effects, has been demonstrated to be a promising compound to treat a variety of NDs. Here, we investigated the potential role of NOB in sodium arsenate (NA)-induced deregulated miRNAs and target proteins in human neural progenitor cells (hNPCs). The proteomics and microRNA (miRNA) profiling was done for different groups, namely, unexposed control, NA-exposed, NA + NOB, and NOB groups. Following the correlation analysis between deregulated miRNAs and target proteins, RT-PCR analysis was used to validate the selected genes. The proteomic analysis showed that significantly deregulated proteins were associated with neurodegeneration pathways, response to oxidative stress, RNA processing, DNA repair, and apoptotic process following exposure to NA. The OpenArray analysis confirmed that NA exposure significantly altered miRNAs that regulate P53 signaling, Wnt signaling, cell death, and cell cycle pathways. The RT-PCR validation studies concur with proteomic data as marker genes associated with autophagy and apoptosis (HO-1, SQSTM1, LC-3, Cas3, Apaf1, HSP70, and SNCA1) were altered following NA exposure. It was observed that the treatment of NOB significantly restored the deregulated miRNAs and proteins to their basal levels. Hence, it may be considered one of its neuroprotective mechanisms. Together, the findings are promising to demonstrate the potential applicability of NOB as a neuroprotectant against chemical-induced neurotoxicity.

Combining immune checkpoint inhibitors, specifically nivolumab (anti-PD-1) and ipilimumab (anti-CTLA-4), holds substantial promise in revolutionizing cancer treatment. This review explores the transformative impact of these combinations, emphasizing their potential for enhancing therapeutic outcomes across various cancers. Immune checkpoint proteins, such as PD1 and CTLA4, play a pivotal role in modulating immune responses. Blocking these checkpoints unleashes anticancer activity, and the synergy observed when combining multiple checkpoint inhibitors underscores their potential for enhanced efficacy. Nivolumab and ipilimumab harness the host’s immune system to target cancer cells, presenting a powerful approach to prevent tumor development. Despite their efficacy, immune checkpoint inhibitors are accompanied by a distinct set of adverse effects, particularly immune-related adverse effects affecting various organs. Understanding these challenges is crucial for optimizing treatment strategies and ensuring patient well-being. Ongoing clinical trials are actively exploring the combination of checkpoint inhibitory therapies, aiming to decipher their synergistic effects and efficacy against diverse cancer types. This review discusses the mechanisms, adverse effects, and various clinical trials involving nivolumab and ipilimumab across different cancers, emphasizing their transformative impact on cancer treatment.

IntroductionAlmost 250 million children fail to achieve their full growth or developmental potential, trapping them in a cycle of continuing disadvantage. Strong evidence exists that parent-focussed face to face interventions can improve developmental outcomes; the challenge is delivering these on a wide scale. SPRING (Sustainable Programme Incorporating Nutrition and Games) aimed to address this by developing a feasible affordable programme of monthly home visits by community-based workers (CWs) and testing two different delivery models at scale in a programmatic setting. In Pakistan, SPRING was embedded into existing monthly home visits of Lady Health Workers (LHWs). In India, it was delivered by a civil society/non-governmental organisation (CSO/NGO) that trained a new cadre of CWs.MethodsThe SPRING interventions were evaluated through parallel cluster randomised trials. In Pakistan, clusters were 20 Union Councils (UCs), and in India, the catchment areas of 24 health sub-centres. Trial participants were mother-baby dyads of live born babies recruited through surveillance systems of 2 monthly home visits. Primary outcomes were BSID-III composite scores for psychomotor, cognitive and language development plus height for age z-score (HAZ), assessed at 18 months of age. Analyses were by intention to treat.Results1,443 children in India were assessed at age 18 months and 1,016 in Pakistan. There was no impact in either setting on ECD outcomes or growth. The percentage of children in the SPRING intervention group who were receiving diets at 12 months of age that met the WHO minimum acceptable criteria was 35% higher in India (95% CI: 4–75%, p = 0.023) and 45% higher in Pakistan (95% CI: 15–83%, p = 0.002) compared to children in the control groups.DiscussionThe lack of impact is explained by shortcomings in implementation factors. Important lessons were learnt. Integrating additional tasks into the already overloaded workload of CWs is unlikely to be successful without additional resources and re-organisation of their goals to include the new tasks. The NGO model is the most likely for scale-up as few countries have established infrastructures like the LHW programme. It will require careful attention to the establishment of strong administrative and management systems to support its implementation.

Ganglion cysts are fluid filled sacs which develop near joints and tendons and are usually asymptomatic. Lower limb ganglion cysts are rare occurrences especially those situated around joint spaces causing nerve compression. We present the case of a 68 year-old female with history of progressive swelling in the left antero-lateral leg, associated with pain, and neurological symptoms of peroneal nerve compression. Magnetic resonance imaging (MRI) revealed a large proximal tibiofibular joint ganglion cyst causing peroneal nerve compression. One year following the left sided presentation, the patient presented with similar but less severe symptoms in her right antero-lateral leg. MRI revealed a small juxta-articular ganglion cyst in the right proximal tibiofibular joint space. We discuss etiology, symptoms, and management of lower limb ganglion cysts.

IntroductionPoor psychosocial support and lack of respectful care for women during childbirth are commonplace in health facilities in low- and middle-income countries. While WHO recommends providing supportive care to pregnant women, there is a scarcity of material for building the capacity of maternity staff to provide systematic and inclusive psychosocial support to women in the intrapartum phase, and prevent work stress and burnout in maternity teams. To address this need we adapted WHO's mhGAP for maternity staff to provide psychosocial support in labour room settings in Pakistan. Mental Health Gap Action Programme (mhGAP) is an evidence-based guidance which provides psychosocial support in resource-limited health care settings. This paper aims to describe the adaptation of mhGAP to develop psychosocial support capacity building materials for maternity staff to provide support to maternity patients, and also to staff, in the labour room context.MethodsAdaptation was conducted within the Human-Centered-Design framework in three phases: inspiration, ideation, and implementation feasibility. In inspiration, a review of national-level maternity service-delivery documents and in-depth interviews of maternity staff were conducted. Ideation involved a multidisciplinary team to develop capacity-building materials by adapting mhGAP. This phase was iterative and included cycles of pretesting, deliberations, and revision of materials. In implementation feasibility, materials were tested via the training of 98 maternity staff and exploring system feasibility via post-training visits to health facilities.ResultsInspiration phase identified gaps in policy directives and implementation and formative study identified limited understanding and skills of staff to assess patients' psychosocial needs and provide appropriate support. Also, it became evident that staff themselves needed psychosocial support. In ideation, team developed capacity-building materials comprising two modules: one dedicated to conceptual understanding, the other to implementing psychosocial support in collaboration with maternity staff. In implementation feasibility, staff found the materials relevant and feasible for the labour room setting. Finally, users and experts endorsed usefulness of the materials.ConclusionOur work in developing psychosocial-support training materials for maternity staff extends the utility of mhGAP to maternity care settings. These materials can be used for capacity-building of maternity staff and their effectiveness can be assessed in diverse maternity care settings.

Objectives The existing literature regarding the mental health consequences of COVID-19 among healthcare workers revolves predominantly around specialised hospital settings, while neglecting primary healthcare workers (PHCW) who are the first point of contact for patients. In view of negligible evidence, this study explored the mental health impact of COVID-19 and health system response, and sought suggestions and recommendations from the PHCWs to address their mental health needs during the pandemic crisis.Design We employed a qualitative exploratory design.Setting A total of 42 primary healthcare facilities across 15 districts in Sindh and Punjab provinces of Pakistan.Participants We telephonically conducted 47 in-depth interviews with health service providers and hospital managers. A combination of inductive and deductive approach was used for data analyses using NVivo V.11.0.Results There was immense fear, stress and anxiety among PHCWs being infected and infecting their families at the beginning of this outbreak and its peak which tapered off over time. It was triggered by lack of information about the virus and its management, false rumours, media hype, lack of personal protective measures (personal protective equipment, PPE) and non-cooperation from patients and community people. Trainings on awareness raising and the PPEs provided by the healthcare system, with emotional support from coworkers and supervisors, were instrumental in addressing their mental health needs. Additionally, they recommended appreciation and recognition, and provision of psychosocial support from mental health professionals.Conclusion Primary healthcare system should be prepared to provide timely informational (eg, continuous updates in training and guidelines), instrumental (eg, provision of PPE, appreciation and recognition), organisational (eg, safe and conducive working environment) and emotional and psychosocial support (eg, frequent or needs-based session from mental health professionals) to PHCWs in order to mitigate the mental health impact of pandemic crisis.

Data integration with phenotypes such as gene expression, pathways or function, and protein-protein interactions data has proven to be a highly promising technique for improving human complex diseases, particularly cancer patient outcome prediction. Hepatocellular carcinoma is one of the most prevalent cancers, and the most common cause is chronic HBV and HCV infection, which is linked to the majority of cases, and HBV and HCV play a role in multistep carcinogenesis progression. We examined the list of known hepatocellular carcinoma biomarkers with the publicly available expression profile dataset of hepatocellular carcinoma infected with HCV from day 1 to day 10 in this study. The study covers an overexpression pattern for the selected biomarkers in clinical hepatocellular carcinoma patients, a combined investigation of these biomarkers with the gathered temporal dataset, temporal expression profiling changes, and temporal pathway enrichment following HCV infection. Following a temporal analysis, it was discovered that the early stages of HCV infection tend to be more harmful in terms of expression shifting patterns, and that there is no significant change after that, followed by a set of genes that are consistently altered. PI3K, cAMP, TGF, TNF, Rap1, NF-kB, Apoptosis, Longevity regulating pathway, signaling pathways regulating pluripotency of stem cells, Cytokine-cytokine receptor interaction, p53 signaling, Wnt signaling, Toll-like receptor signaling, and Hippo signaling pathways are just a few of the most commonly enriched pathways. The majority of these pathways are well-known for their roles in the immune system, infection and inflammation, and human illnesses like cancer. We also find that ADCY8, MYC, PTK2, CTNNB1, TP53, RB1, PRKCA, TCF7L2, PAK1, ITPR2, CYP3A4, UGT1A6, GCK, and FGFR2/3 appear to be among the prominent genes based on the networks of genes and pathways based on the copy number alterations, mutations, and structural variants study.

Objectives A dearth of qualitative studies constrains in-depth understanding of health service providers’ perspectives and experiences regarding the impact of COVID-19 on their mental health. This study explored the mental health impact and needs of of public sector healthcare workers during COVID-19 who working in secondary-level and tertiary-level healthcare settings of Pakistan.Design An exploratory qualitative study.Setting Twenty-five secondary-level and eight tertiary-level public hospitals of Sindh and Punjab provinces of Pakistan.Participants In-depth interviews were conducted with 16 health service providers and 40 administrative personnel. Study data were analysed on NVivo V.11 using the conventional content analysis technique.Results The study identified three overarching themes: (1) mental health impact of COVID-19 on health service providers that included the fear of acquiring the infection and transmitting it to their family members, fear of social isolation and stigma, anxiety related to the uncertainty of COVID-19, nervousness due to media exaggeration and stress associated with excessive workload; (2) mental health needs of health service providers involved in the COVID-19 crisis and available support from the healthcare system, including the expression of the need for counselling services and safe working conditions, the need for paid rest periods, and the need for appreciation and motivation to work in the pandemic; and (3) suggestions to address mental health needs of healthcare workers, including provision of specialised mental healthcare/services, formal training of health managers on managing mental health needs of health facility staff, and assessment and addressing of these needs of the health workforce.Conclusion The study emphasises the need to strengthen health system preparedness for recognising and addressing the needs of healthcare professionals. At the system level, there is a need for a specialised unit to provide mental health services and better communication strategies. At the staff level, continuous motivation and appreciation should be given to healthcare professionals either through monetary incentives or formal acknowledgement of their performance.

Using the water footprint (WF) approach to evaluate the water-use efficiency in agricultural production is crucial for assessing the sustainable use of water resources and mitigating water scarcity and pollution. This study calculated the blue, grey, green and total water footprints of spring maize production in Northeast China in 2019 and 2020 and compared the water footprint values at the provincial and municipal scales. In addition, this study analyzed the spatial variation and drivers of the water footprint. The results show that the average water footprints of spring maize production in Northeast China in 2019 and 2020 were 1.78 m3kg−1 and 2.00 m3kg−1, out of which the grey water footprint contributed the most, accounting for 55.19% and 49.85% of the total water footprint, respectively, while the blue water footprint contributed the least, accounting for only 17.44% and 18.68% of the total water footprint. At the provincial level, the water footprint of spring maize production in Northeast China was spatially clustered, with the lowest total water footprint in Heilongjiang Province and the highest total water footprint in Jilin Province. The spatial distribution difference of the spring maize unit yield was the fundamental factor explaining the difference in the water footprint. The precipitation, surface water resources, average temperature, effective irrigated area and the proportion of effective irrigated area also had impacts on the water footprint. This study provides a scientific basis for optimizing the distribution of spring maize production in Northeast China, formulating appropriate sustainable water resource management plans, improving water-use efficiency and realizing sustainable water resource management in Northeast China.

The interactions between household size, capital, and adaptation to social-ecological change has been widely studied; however, little is known about the differences in everyday adaptation to social-ecological change across household structures. Joint family households are increasing in contexts where the nuclear family had previously been the norm, and remains a prevalent structure throughout the world. Thus, it is important to understand how these structures influence adaptation decision-making processes and outcomes. We draw on a survey of 448 self-identified household heads in three communities in northwestern Pakistan to assess everyday adaptation to social-ecological change. We demonstrate that livelihood and adaptation strategies vary across joint and nuclear family household structures because, in part, of joint family households’ greater access to natural and human capital in comparison to nuclear family households. Finally, household livelihood decision makers often include other family members to expand beyond the often-assumed husband-wife dyad. Our work highlights how everyday adaptations are expressions of existing opportunities in the space in which households are located, access to capital and resources that differ across household structures, and of various dynamics associated with household decision making. This points to the need for a nuanced understanding of how household structure influences everyday adaptation to social-ecological change and thereby shows the ways in which adaptive capacity is embedded within existing social systems and relationships, such as household structures.

Abstract Cytochrome c (cyt c) is widely used as a model protein to study (i) folding and stability aspects of the protein folding problem and (ii) structure–function relationship from the evolutionary point of view. Databases of cyts c now contain 285 cyt c sequences from different organisms. A sequence alignment of all these proteins with respect to horse cyt c led to several important conclusions. One of them is that Leu94 is always conserved in all 30 mammalian cyts c. It is known that mutation L94G of the wild type (WT) horse cyt c is destabilizing and mutant exists as molten globule under the native condition (buffer pH 6 and 25 °C). We have expressed and purified uniformly labeled (13C and 15N) and unlabeled WT horse cyt c and its L94G mutant. We report that labeling does not affect the thermodynamic stability of proteins. To support this conclusion, the secondary and tertiary structure of each protein in labeled and unlabeled forms was determined by conventional techniques (UV–Vis absorption and circular dichroism spectroscopy).

Objective: To assess the reliability and concurrent validity of Cognitive Distortions Scale-Urdu based on Beck's Cognitive Model of psychopathology on patients diagnosed with mental disorders. Method: The correlational study was conducted from June 15, 2019, to January 30, 2020, in Lahore, Pakistan, and comprised psychiatric patients of either gender aged 18-65 years from six government hospitals, including Mayo Hospital, Services Hospital, Punjab Institute of Mental Health, Sir Ganga Ram Hospital, Gulab Devi Hospital and the Combined Military Hospital. The participants completed the demographic information form and the Cognitive Distortions Scale-Urdu. The latter was re-administered after a gap of two weeks to determine its internal consistency and test-retest reliability. Feinstein Paranoia, Subjective Wellbeing and Siddiqui Shah Depression Scales were administered along with the Cognitive Distortions Scale-Urdu to determine its concurrent validity. Statistical analysis was done using SPSS 24. Results: Of the 106 patients, 56(52.8%) were recruited for reliability analysis with an overall mean age of 32.31+/-10.62 years, and 50(47.2%) for concurrent validity analysis with an overall mean age of 31.30+/-10.52 years. Correlation analysis indicated good internal consistency (?=0.87), test retest reliability (r=0.86) and moderately high concurrent validity of the scale (rang: 0.44-0.89). Conclusion: The Cognitive Distortions Scale-Urdu was found to have sound psychometric properties and was suitable for researchers to obtain quantitative estimates of the frequency and intensity of cognitive distortions in clinical samples. Key Words: Cognitive distortions scale, Reliability, Validity, Clinical population, Mental disorders. Continuous...

The computational study of a novel charge-transfer complex as a photoactive blend for potential application in dye-sensitized solar cells was carried out using the semi-empirical method. The adsorption of two natural dyes, 1S,3R,4R,5R-3-(3,4-dihydroxyphenyl)acryloyloxy)-1,4,5-trihydroxycyclohexane carboxylic acid (DHTH) and 2-Phenyl-4H-chromen-4-one (PCO) was achieved independently on to 1×1×1 TiO2 crystal to form TiO2-DHTH and TiO2-PCO adsorption complexes. Semiempirical calculations were performed on the optimized molecules, as well as on the adsorption complexes, to obtain the total energies and EHOMO/ELUMO values, manifesting a flow of electrons from DHTH/PCO to TiO2. The theoretical electronic absorption spectra calculated via ZINDO/s method revealed a large bathochromic shift to 810 nm and 526 nm for TiO2-DHTH and TiO2-PCO, respectively, indicating the formation of a charge-transfer complex. Subsequently, the co-adsorption of PCO and DHTH on TiO2 was accomplished with the aim to minimize the possible charge recombination in the photoactive blend. The semiempirical PM3 calculations evidenced the high stability of the co-adsorption complex, TiO2-PCO-DHTH, with the total energy of -200678.578 kcal/mol. The positions of HOMO and LUMO orbitals as obtained from single-point energy calculations, coincided accurately with our proposition of electron flow in a cascade manner from DHTH to PCO and finally to TiO2. The theoretical electronic absorption spectrum ofTiO2-PCO-DHTH evinced absorption range of 351.8-800 nm demonstrating the high potential of TiO2-PCO-DHTH to be used as a photoactive blend for solar cells.

The removal of heavy metals from water is very difficult. For this reason different methods have been employed so far among which biosorption is the cheapest and ecofriendly way to treat and remove heavy metals from aqueous media. Present study, investigated the ability of potato peel husk (PPH), potato peel husk modified with lemon juice (LMPPH) and potato peel husk modified with lemon juice & microwave (MLMPPH) for the removal of Pb (II) from water. Organic adsorbent was activated by lemon juice & microwave and was characterized by SEM, EDX and FTIR. Adsorption mechanism (batch parameters) and isothermal studies (Langmuir, Freundlich, Temkin isotherms) revealed the best fitness of Freundlich isotherm from the R2 values indicating physisorption. Results of kinetic studies (pseudo first and second order and intraparticle diffusion) showed that reaction followed pseudo second order kinetics. In thermodynamic study reaction was exothermic (ΔH was negative). The ability of PPH, LMPPH and MLMPPH for removal of lead was also investigated in column studies (bed height, flow rate, influent concentration).Thomas Morrison adsorption model described breakthrough data. Recent study proved that activation of potato peel husk with lemon juice and microwave (MLMPPH) not only increased the sorption capacity of sorbent much more as compared to PPH and LMPPH due to the introduction of excess COOH groups with lemon juice but also their activation as COO- with microwave exposure.

Abstract Background Recovery Education Centres (RECs) are increasingly implemented to support the process of recovery for individuals experiencing mental health challenges. However, the evidence on key REC mechanisms and outcomes, particularly for diverse subpopulations or service delivery contexts is scant. This study identified mechanisms and outcomes of an REC focused on adults with mental health challenges transitioning from homelessness. Methods Qualitative methods were used to explore in-depth the experiences of homeless and unstably housed participants experiencing mental health challenges in Toronto, Canada. Twenty service users participated in semi-structured interviews between July 2017 and June 2018, six to 14 months following REC enrollment. A realist informed interview guide explored participants’ perspectives on key REC mechanisms and outcomes. Interviews were audio-recorded, transcribed verbatim and analyzed using inductive thematic analysis. Investigator triangulation and member checking processes enhanced analytical rigour. Results Participants perceived that program participation supported the process of recovery through several mechanisms: a judgment-free environment; supportive relationships, mutuality and role modelling; deconstruction of self-stigma; and reclaiming of one’s power. Participants described several outcomes at the personal, interpersonal and social levels, including improvements in health and well-being; self-esteem, confidence and identity; sense of empowerment, control and personal responsibility; as well as improvements in interpersonal skills, pro-social behaviours and ability to self-advocate; and increased goal development and future orientation. Conclusions Findings suggest RECs can support the process of recovery among people transitioning from homelessness and can successfully support subpopulations experiencing mental health challenges and social disadvantage.

Mistreatment with women during childbirth is prevalent in many in low- and middle-income countries. There is dearth of evidence that informs development of health system interventions to promote supportive and respectful maternity care in facility-based settings. We examined health systems bottlenecks that impedes provision of supportive and respectful maternity care in secondary-level public healthcare system of Pakistan. Using a qualitative exploratory design, forty in-depth interviews conducted with maternity care staff of six public health facilities in southern Pakistan. Development of interview guide and data analyses were guided by the WHO's six health system building blocks. A combination of inductive and deductive approach was used for data analyses. Our study identified range of bottlenecks impeding provision of RMC. In terms of leadership/governance, there was lack of institutional guidelines, supervision and monitoring, and patient feedback mechanism. No systematic mechanism existed to screen and record patient psychosocial needs. Health workforce lacked training opportunities on RMC that resulted in limited knowledge and skills; there were also concerns about lack of recognition from leadership for good performers, and poor relationship and coordination between clinical and non-clinical staff. Regarding the domain of service delivery, we found that patients were perceived as un-cooperative, non-RMC manifestations were acceptable and normalized under certain conditions, and restrictive policies for active engagement of companions. Finally, lack of cleanliness, curtains for privacy, seating arrangement for companion were the identified issues infrastructural issues. A service-delivery intervention package is needed that effectively uses all six components of the health system: from investments in capacity building of maternity teams to creating a conducive facility environment via proper governance and accountability mechanisms. Such interventions should not only focus on provision of maternity care in a respectful and dignified manner, but also ensure that care is responsive to the psychosocial needs of pregnant women without any discrimination.

Introduction Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities. Methods Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO’s intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams’ understanding and attitude towards SDMC. Additionally, women’s maternity experiences and psycho-social well-being—will inform the success of the intervention. Expected outcomes Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518).

Background: The World Health Organization and others promote responsive caregiving to support all children to thrive, particularly in low- and middle-income countries. The 14-item Mother’s Object Relations Scales – Short Form (MORS-SF) may be of use in research and public health programmes because of its basis in attachment theory and ability to capture parental feelings towards their child. Methods: We culturally adapted the MORS-SF for use with mothers in the SPRING home visits trial when their infants were 12 months old. The same dyads were assessed using the HOME inventory concurrently and Bayley Scales of Infant Development III (BSID-III) at 18 months of age. Mixed effects linear regression was used to examine associations between MORS-SF (explanatory variable) and HOME-IT, and the cognitive, language and motor domains of BSID-III (outcome variables). Results: 1273 dyads completed all assessments. For the motor and language BSID-III scales and for HOME-IT there were strong and positive associations with the MORS-SF warmth sub-scale, and strong and negative associations with the invasion sub-scale. Important but less strong associations were seen with the BSID-III cognitive scale. Evidence of interaction suggested that both are individually important for child development. Conclusions: This is the first time MORS-SF has been used in India where optimising responsive caregiving is of importance in supporting all children to reach their potential. It is also the first time that the tool has been used in relation to child development. MORS-SF could be a valuable addition to evaluation in early childhood development.

Poor soil organic matter is one of the major causes of the deterioration of soil health. Most soils fertility is also decreased when enough organic carbon is not present in the soil. Maize is most susceptible to this poor soil fertility status. A significant amount of maize growth and yield is lost when it is cultivated in low organic matter and poor fertility soil. To overcome this issue organic amendments can play an imperative role. Biochar and vermicompost are organic amendments that can not only improve organic residues but also increase soil nutrient concentration. The current experiment was conducted to explore the sole and combined application of both organic amendments with recommended NPK fertilizer. Four treatments were tested i.e., control, biochar (BC1), vermicompost (VC1) and VC1+BC1 with and without nitrogen (N), phosphorus (P) and potassium (K) in the experiment. Results showed that VC1+BC1+NPK performed significantly best for improvement in maize plant height (6.25 and 3.00%), 1000 grains weight (30.48 and 29.40%), biological yield (18.86 and 43.12%) and grains yield (30.58 and 39.59%) compared to BC0+VC0+NPK and control respectively. A significant improvement in soil N, P and K also validated the efficacious role of VC1+BC1+NPK over BC0+VC0+NPK and control. Treatment VC1+BC1+NPK is recommended for the achievement of better maize growth and yield in poor organic matter soils. More investigations are suggested in variable climatic conditions to declare VC1+BC1+NPK as the best amendment compared to control for enhancing soil N, P and K status as well as maize productivity.

Mobility is an intrinsic feature of the animal kingdom that stimulates evolutionary processes and determines the biological success of animals. Skeletal muscle is the primary driver of voluntary movements. Besides, skeletal muscles have an immense impact on regulating glucose, amino acid, and lipid homeostasis. Muscle atrophy/wasting conditions are accompanied by a drastic effect on muscle function and disrupt steady-state muscle physiology. Cachexia is a complex multifactorial muscle wasting syndrome characterized by extreme loss of skeletal muscle mass, resulting in a dramatic decrease in life quality and reported mortality in more than 30% of patients with advanced cancers. The lack of directed treatments to prevent or relieve muscle loss indicates our inadequate knowledge of molecular mechanisms involved in muscle cell organization and the molecular etiology of cancer-induced cachexia (CIC). This review highlights the latest knowledge of regulatory mechanisms involved in maintaining muscle function and their deregulation in wasting syndromes, particularly in cachexia. Recently, protein posttranslational modification by the small ubiquitin-like modifier (SUMO) has emerged as a key regulatory mechanism of protein function with implications for different aspects of cell physiology and diseases. We also review an atypical association of SUMO-mediated pathways in this context and deliberate on potential treatment strategies to alleviate muscle atrophy.

Globally, people are highly affected by Cadmium (Cd), the most hazardous heavy metal. It has been implicated in various pathogeneses. Oxidative stress may be one the main reasons for Cd-induced disorders in the body. This article investigates the protective ability of Catharanthus roseus (CR) extract on oxidative stress in the kidney and liver of rats exposed to Cd. After 21 days, a significant increase in MDA concentration (6.81 ± 0.05), (6.64 ± 0.03) was observed in Cd-treated groups compared to the control (5.54 ± 0.02), (5.39 ± 0.04) for the kidney and liver, respectively, while significant changes were observed in the haematological parameters. Antioxidant enzymes, GPx, CAT, and SOD showed a significant decrease in their activity. We established that increasing the concentration of Cd in the presence of H2O2 was able to cause stand scission in pBR322 plasmid DNA, which may be due to the mediation of ROS generated in the process. The antioxidant ability of CR extract was tested in DPPH and H2O2 scavenging assay, depicted by the increase in the percentage inhibition. Upon treatment of CR extract to rats, MDA concentration was decreased for the kidney and liver compared to the Cd-treated groups. This was again confirmed by comet assay of both tissues, where the degree of cellular DNA breakage caused by Cd toxicity decreased significantly upon treatment with CR extract. Overall, the results suggest that Cd plays a major role as an effector metal ion, causing a decrease in the concentration and activity of AO enzymes and enhanced lipid peroxidation. ROS production resulted in oxidative DNA damage within the cell, whereas CR extract showed potential antioxidant activity against ROS-mediated DNA damage induced by Cd poisoning.

The core objective of the research conducted is to explore the interactions of stock index, gold price, crude oil price and exchange rate in Pakistan from September 1997 to April 2018. The interaction is examined by concurrent equations. For analyzing the trend of Pakistan economy, unit root test, correlation test, co-integration technique, vector autoregressive model, granger test is done. The result indicates absence of long run relationship among all of the variables. However, results demonstrate significant effect of crude oil price & Gold price on exchange rate. Whereas, Pakistan stock market is affected by exchange rate. Recommendations for the government are given to give more focus on economic policies for crude oil price, stock index, gold price and exchange rate to make them stable in the country. The study is tremendously beneficial for high authorities in business, policy and decision maker in the country and as well as investors because they can predicate and able to understand the fluctuation of these variables in the economy. Statistical software used for this study is EVIEWS 9th edition.

Social-ecological change has placed unprecedented stress on water resources throughout the world. This has driven water users to employ a diverse range of adaptation strategies and necessitates new governance structures, such as adaptive water governance (AWG), which have the capacity to manage resources in the midst of uncertainty and complexity. As such, AWG has the potential to support household adaptation strategies; however, little empirical work has been done to identify the factors that facilitate the emergence of AWG. To address this gap, we conducted a household survey of 448 households in northwestern Pakistan, a post-conflict, water-scarce area where adaptive governance is needed to support rural livelihoods in the midst of numerous socioeconomic and environmental transformations. Indeed, we found that households in our study area perceived a range of changes to the water system, including but not limited to declines of fish populations, decreased quality and amount of river water, and an increase of local tourism. Respondents reported a range of adaptation strategies including increasing agricultural inputs, planting new crop varieties, and changing their domestic water supply system. In some cases, households employed these adaptation strategies despite economic barriers, and although many were willing to go against friends’ and community leaders’ opinions to adapt, and they were less likely to counter the opinions of family members. This reveals that households negotiate multiple factors in their decisions to adapt to social-ecological change; as such, there is a great need for flexible and collaborative governance systems such as AWG to support this complexity in household adaptation decision making. Further, we argue that the varying roles of social influence should be considered to align governance structures with household decision-making processes. Thus, we suggest that AWG will be more likely to emerge when decision makers involved in water management draw on existing informal institutions and cross-sectoral collaboration to reflect the complex ways water users adapt to social-ecological change.

A pot experiment was conducted in the greenhouse to assess the effect of wheat straw derived biochar on the bioavailability of Pb, Cd and Cr using maize as test crop. Surface (0–20 cm) soil collected from the research farm of The University of Agriculture Peshawar was amended with 0, 2, 4 and 6% biochar respectively. Ten kg soil was placed in pots and all pots were spiked with Pb, Cd and Cr at concentrations 0, 5, 10 and 50 mg kg−1 of each element. The experiment was conducted in a completely randomized design, replicated three times. Maize seeds were sown in pots in wetter conditions. Soil and plant samples were taken at harvest time. Results show that soil Pb, Cd and Cr reduced from 15.5, 5.38 and 5.85 mg kg−1 in control to 1.34, 0.69 and 0.75 mg kg−1 respectively with application of 6% biochar when values were averaged over the contamination levels. Similarly, Pb, Cd and Cr accumulation in plant were reduced by the application of biochar as compared to control. As compared to control, there was a significant improvement in the plant growth with biochar at elevated levels of Pb, Cd and Cr in soil. Overall, the application of wheat straw biochar might be effective in immobilization of metal in the soil and reducing its uptake to plant. However, investigation of the residual effect of biochar is required for sustainable use of biochar for remediation of contaminated soil.

An experiment was performed to investigate the effect of integrated phosphorus management with previously applied biochar at the University of Agriculture, Peshawar during 2018–2019. The treatments comprised of two levels of biochar (10 tons ha−1 and no biochar) and three sources of P {Farmyard manure, poultry manure, and an inorganic source di-ammonium phosphate}. The phosphorous sources were added in such a manner that 100, 75 and 50% of P were received from the organic sources and the remaining were obtained from the inorganic source and vice versa @ 100 kg P ha−1. This experiment was much needed for our conditions to formulate the recommended organic and mineral fertilizers for our soil, because our famers uses mineral fertilizers without any specific calculation and time which degrade and erode the soil day by day. The experiment was designed in RCB and repeated three times. The size of plot was kept as 21 m2 with strong ridges around each plot. Biological yield (7829 kg ha−1), grain yield (3200 kg ha−1), soil organic matter (1.71%), soil P content (4.28 mg kg−1), straw P content (0.07%) and grain P content (0.21%) were significantly greater with 10 tons ha−1 of residual biochar treatment. However, more thousand grain weight (52.3 g), soil organic matter (2.05%), straw P content (0.096%) and grain P content (0.25%) were significantly enhanced with the application of 100% P from PM only whereas, biological yield (9789 kg ha−1) and grain yield (4334 kg ha−1) were enhanced with application of P as 50% from PM and 50% from DAP. Soil phosphorus was significantly increased with the application of FYM. These results suggested that addition of biochar at the rate of 10 tons ha−1 in the previous season along with 100% P from PM in the current season improved yield and yield components and soil physico-chemical properties and is therefore recommended for Peshawar valley.

Non-syndromic oculocutaneous albinism (nsOCA) is an inherited disorder of melanin biosynthesis with autosomal recessive mode of inheritance, presenting either hypopigmented or depigmented skin, hair, and eyes. It is genetically heterogeneous with seven loci (OCA1–OCA7) reported to date. In the present study, we have reported three consanguineous families (A, B, C) presenting identical nsOCA phenotypes. Sanger sequencing revealed a novel [NM_000372.5: c.826 T > C, p.(Cys276Arg)] and a recurrent variant [NM_000372.5: c.832C > T, p.(Arg278∗)] in tyrosinase (TYR) in families A and B, respectively. Microsatellite marker-based homozygosity mapping linked family C to OCA4. Sequence analysis identified a novel insertion variant (NM_016180.5: c.1331_1332insA) in the SLC45A2. Further, in silico mutagenesis and dynamic simulation approaches revealed that a novel Cys276Arg variant abolished the cysteine bridge and might contribute toward decreased stability of the TYR protein. Our study expands the mutation spectrum of the TYR and SLC45A2 genes and emphasizes that molecular investigations are essential for accurate disease diagnosis.

MXenes present unique features as materials for energy storage; however, limited interlayer distance, and structural stability with ongoing cycling limit their applications. Here, we have developed a unique method involving incorporating Nb atoms into MXene (Ti3C2) to enhance its ability to achieve higher ionic storage and longer stability. Computational analysis using density functional theory was performed that explained the material structure, electronic structure, band structure, and density of states in atomistic detail. Nb-doped MXene showed a good charge storage capacity of 442.7 F/g, which makes it applicable in a supercapacitor. X-ray diffraction (XRD) indicated c-lattice parameter enhancement after Nb-doping in MXene (from 19.2A° to 23.4A°), which showed the effect of the introduction of an element with a larger ionic radius (Nb). Also, the bandgap changes from 0.9 eV for pristine MXene to 0.1 eV for Nb-doped MXene, which indicates that the latter has the signature of increased conductivity due to more metallic nature, in support of the experimental results. This work presents not only the effect of doping in MXene but also helps to explain the phenomena involved in changes in physical parameters, advancing the field of energy storage based on 2D materials.

In view of the immense capability of plants this work is planned to employ seed extract as a source for the reduction of Cu ions in to Cu nanoparticles (Cu NPs). For this purpose seed extract of Trigonella foenum-graecum (fenugreek seeds) was utilized as a substitute of classical methods. This green path for synthesizing Cu NPS is easy, natural, low cost, sustainable and eco-friendly as compared to conventional methods. In this experiment harmful chemical/physical methods for the production of Cu nanoparticles is replaced by using minimum concentration of seed extract. The stepwise characterization was done by using Atomic Absorption spectroscopy, UV-Vis Spectroscopy, FTIR spectrophotometer and X-ray diffraction (XRD) which have given much valuable information about these materials. Antibacterial activity of these nanoparticles is observed at different concentration so their ZOI (Zone of inhibition) and MIC (minimum inhibitory Concentration) was also calculated against four human pathogenic strains.

IntroductionEarly childhood development is key to achieving the Sustainable Development Goals and can be negatively influenced by many different adversities including violence in the home, neglect, abuse and parental ill-health. We set out to quantify the extent to which multiple adversities are associated with impaired early childhood growth & development.MethodsThis was a substudy of the SPRING cluster randomised controlled trial covering the whole population of 120 villages of rural India. We assessed all children born from 18 June 2015 for adversities in the first year of life and summed these to make a total cumulative adversity score, and four subscale scores. We assessed the association of each of these with weight-for-age z-score, length-for-age z-score, and the motor, cognitive and language developmental scales of the Bayley Scales of Infant Development III assessed at 18 months.ResultsWe enrolled 1726 children soon after birth and assessed 1273 of these at both 12 and 18 months of age. There were consistent and strongly negative relationships between all measures of childhood adversity and all five child growth & development outcome measures at 18 months of age. For the Bayley motor scale, each additional adversity was associated with a 1.1 point decrease (95%CI -1.3, -0.9); for the cognitive scales this was 0.8 points (95%CI -1.0, -0.6); and for language this was 1.4 points (95%CI -1.9, -1.1). Similarly for growth, each additional adversity was associated with a -0.09 change in weight-for-age z-score (-0.11, -0.06) and -0.12 change in height-for-age z-score (-0.14, -0.09).DiscussionOur results are the first from a large population-based study in a low/middle-income country to show that each increase in adversity in multiple domains increases risk to child growth and development at a very early age. There is an urgent need to act to improve these outcomes for young children in LMICs and these findings suggest that Early Childhood programmes should prioritise early childhood adversity because of its impact on developmental inequities from the very start.

Management of inorganic fertilizer is very important to obtain maximum crop yield and improved nutrient use efficiency in cereal crops. Fixation of phosphatic fertilizers in alkaline soils due to calcareousness is one of the major hurdles. It induces phosphorus nutritional stress that can decrease the yield of maize and wheat. Selection of a suitable application method and proper stage of crop for phosphorus (P) fertilizer has prime importance in better uptake of P and crop production. Among different application methods, soil and foliar application are widely adopted. In wheat and maize, knee height + tasseling and stem elongation + booting are critical stages towards P deficiency. That is why field trials were conducted to evaluate the supplemental effect of foliar P on maize and wheat yields. For that, 144 mM KH2PO4 was applied as foliar at knee height + tasseling and stem elongation + boot stages in maize and wheat, respectively. Soil application of 0, 20, 40 and 60 kg P ha−1 was done through broadcast and band methods. Results showed that foliar spray of 144 mM KH2PO4 at knee height + tasseling and stem elongation + boot stages in wheat and maize significantly enhanced grains yield and phosphorus use efficiency (PUE) where P was applied as banding or broadcast at the time of sowing. A significant decreasing trend in response to increasing soil P levels validated the efficacious role and suitability of foliar P. In conclusion, the use of P as foliar at knee height + tasseling and stem elongation + boot stages is an efficacious way to manage P fertilizer.

The UF membrane with a narrow and uniform pore size distribution and a low tendency to foul has significant applications in wastewater treatment. A major hindrance in the preparation of the UF membrane with these features is the lack of a scalable and economical membrane fabrication method. Herein, we devise a new strategy to prepare a high-quality polyvinylidene fluoride/polymethyl acrylate/cellulose acetate (PVDF/PMMA/CA) blend UF membrane via a combination of the etching mechanism with the traditional Loeb–Sourirajan (L-S) phase inversion method. Different concentrations of silicon dioxide (SiO2) nanoparticles (NP) in the membrane matrix were etched by using a 0.2 M hydrofluoric acid (HF) solution in a coagulation bath. This strategy provided the membrane with unique features along with a narrow and uniform pore size distribution (0.030 ± 0.005 μm). The etched membrane exhibits an increase of 2.3 times in pure water flux (PWF) and of 6.5 times in permeate flux(PF), with a slight decrease in rejection ratio (93.2% vs. 97%) when compared to than that of the un-etched membrane. Moreover, this membrane displayed outstanding antifouling ability, i.e., a flux recovery ratio (FRR) of 97% for 1000 mg/L bovine serum albumin (BSA) solution, a low irreversible fouling ratio of 0.5%, and highly enhanced hydrophilicity due to the formation of pores/voids throughout the membrane structure. The aforementioned features of the etched membrane indicate that the proposed method of etching SiO2 NP in membrane matrix has a great potential to improve the structure and separation efficiency of a PVDF/PMMA/CA blend membrane.

Background: Heel pain is one of the most common foot problems especially among older individuals. Mechanical factors play very important role in heel pain. Pain under the heel on weight bearing can cause disability towards movement. Objective: The objective of the study was to compare the effectiveness of planter facilities taping and calcaneal taping along with stretching and therapeutic ultrasound on heel pain. Methodology: It was a Quasi experimental study in which data was collected from Canada Orthopedic and Rehabilitation Center. Non Probability convenience sampling technique was used for sample collection and patient were assigned in two groups. Data was collected by using prescribed validated questionnaire, which include Standardized Visual Analogue Scale (VAS) and Foot Function Index Scale (FFI). Results: The Comparison of percentage of pain decrease post-treatment after evaluation on VAS and FFI in both groups. The decrease of pain in both indicators was significantly higher in group-A (Planter fasciitis tapping group) as compared to group-B (Calcaneal taping group). The decrease of pain in VAS significant at P=0.019 and in FFI at P =0.000 level showing that plantar fasciitis taping is more effective than calcaneal taping. Conclusion: Plantar fasciitis taping is more effective than Calcaneal taping in planter heel pain. Key Words: Heel Pain, Activities of Daily Living, Calcaneal Taping

The pollution status of Lahore branch canal was determined by physical, chemical and metal constituents because the water is used for irrigation of lands in and around the city. The average result of each physical, chemical and metal parameter at 12 different sites (Location-1 to Location-12) of Lahore branch canal was compared with Food and Agricultural organization (FAO). All physical and chemical parameters were within standards limit while metals concentrations were found in variable quantities in canal water samples. cadmium, copper and chromium concentration was found much higher than the permissible FAO standards.